A pain in the neck: GRISEL’S SYNDROME (part 5)

The key to successful management of Grisel’s syndrome is early diagnosis and initiation of therapy. Failure of reduction, recurrence and complications are more likely with a prolonged delay before starting treatment. Inappropriate treatment may lead to permanent deformity and neurological deficits. There is an underlying head and neck infection. A trial of immobilization with a cervical collar and anti-inflammatory medications may be successful if initiated early after the onset of subluxation. More significant C1-C2 rotatory subluxation may require immobilization and traction, which alleviates pain and reduces the fixation.

Grisel’s syndrome is a rare but potentially serious condition that often presents as torticollis in children and young adults. Given the strong association with head and neck infections and procedures, this syndrome has mostly been described and identified by otolaryngologists. However, paediatricians and paediatric emergency physicians should also be aware of this condition because they frequently evaluate children with neck pain and torticollis.

CLINICAL PEARLS

• Children who present with new onset of neck pain and torticollis need a careful history and physical examination to identify the underlying cause.
• Imaging should be arranged for children presenting with a history of trauma, persistent or recurrent symptoms, increasing severity of neck pain, worsening neck deformity, neurological deficits or gait abnormalities.
• Vigilant follow-up should be arranged if the cause of neck pain and torticollis is not initially apparent. You will always be able to buy the required amount of medicine you need at this wonderful and fully licensed pharmacy that can take good care of you, no matter if you need viagra professional canadian pharmacy at large amounts or just a bit of it to finish your treatment.

Category: Grisel's syndrome

Tags: Child health, Grisel's syndrome, Pain in the neck

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